Healthcare Provider Details

I. General information

NPI: 1164350195
Provider Name (Legal Business Name): MARY BRIDGET MCCARTHY APC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 LA FRANCE ST NE APT 530
ATLANTA GA
30307-2943
US

IV. Provider business mailing address

1450 LA FRANCE ST NE APT 530
ATLANTA GA
30307-2943
US

V. Phone/Fax

Practice location:
  • Phone: 612-419-3760
  • Fax:
Mailing address:
  • Phone: 612-419-3760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC010478
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: